Clinical Characterization of Insomnia among Veterans with PTSD: Identifying Risk Factors for Diagnosis and Treatment with Sedative-Hypnotics

Abstract

Insomnia is prevalent among Veterans with post-traumatic stress disorder (PTSD), it exacerbates PTSD symptoms, and it contributes to impaired functioning and quality of life. To improve treatment outcomes, it is important to identify risk factors for insomnia and sedative-hypnotic use. Classification and regression trees and logistic regression models were used to identify variables associated with insomnia or sedative-hypnotic use. Key findings include low insomnia diagnosis rates (3.5–5.6%) and high rates of sedative-hypnotics (44.2–49.0%). Younger Veterans and those without a breathing-related sleep disorder (BRSD) were more likely to receive an insomnia diagnosis. Veterans with greater service connection and those with an alcohol/substance use disorder were more likely to be prescribed sedative-hypnotics. Interaction terms may have identified potential groups at risk of being under-diagnosed with insomnia (i.e. non-black Veterans with psychiatric co-morbidity, black Veterans without psychiatric co-morbidity) as well as groups at risk for sedative-hypnotic use (i.e. younger Veterans without BRSD). In sum, Veterans with PTSD have high rates of sedative-hypnotic use despite minimal evidence they are effective. This is counter to recommendations indicating behavioral interventions are the first-line treatment. Policy changes are needed to reduce use of sedative-hypnotics and increase access to behavioral insomnia interventions.     

‘The only good jihadist is a dead jihadist’:Boko Haram and de-radicalization around Lake Chad

ABSTRACT

This article discusses the shortcomings of the “de-radicalization doctrine” in sub-Saharan Africa. The issues raised are illustrated by the war against Boko Haram, which involves Nigeria, Niger, Chad and Cameroon. Relying on interviews with security officers, insurgents, civil servants, displaced people, humanitarian workers and Muslim and Christian clerics in Nigeria, Niger and Chad since 2005, the investigation shows that the four states focused on repression rather than demobilisation programs in prison or outdoors. The Boko Haram crisis is mainly a story of mismanagement. The article thus challenges the assumptions of the “de-radicalization doctrine” in Muslim Africa South of the Sahara. First, attempts to de-radicalize jihadi terrorists tend to focus too much on religious fanaticism and the exegesis of the Quran. Secondly, they are neither feasible nor efficient. Finally, they obscure priorities that are more important to counter extremism and demobilize insurgents.     

THE F‐35 JOINT STRIKE FIGHTER AS A SOURCE OF INNOVATIon AND EMPLOYMENT: SOME INTERIM RESULTS

The F‐35 Joint Strike Fighter (JSF) programme is important for innovation in the Dutch economy and also contributes to other programmes in the aerospace industry (spin‐off) and other industries (spillover). On top of the expected value of US$9.2 billion in development and production, based on interviews with 10 companies and research institutes, an expected spin‐off of US$1.1 billion and an expected spillover of US$120 million will result. In addition, over 23,000 man‐years are associated with the activities in the development and production of the JSF. This study excludes the large and labour‐intensive Maintenance, Repair and Overhaul (MRO) activities. Further validation of data and an update of current results is planned for 2006.     

NUCLEAR WEAPONS AS THE CURRENCY OF POWER

There are important similarities between the pattern of behavior Karl Marx identified with respect to commodities—a pattern he called “fetishism”—and the pattern of behavior identified in this article with respect to military force. Marx identified money as the mature expression of commodity fetishism; the author identifies nuclear weapons as the mature expression of the fetishism of force. As such, nuclear weapons function as the currency of power in the international system. This article lays out a theory of nuclear fetishism by adapting four themes that are characteristic of the pattern of behavior known as fetishism: materiality, historicality, efficacy, and reification. By applying these categories to the fetishism of nuclear weapons, the author shows that nuclear weapons represent a new social form consistent with, yet distinct from, other fetish objects.     

一种基于层次分析法的舰炮武器系统选型综合评价模型

针对舰炮武器系统选型配置决策中众多制约因素难以平衡兼顾的难题,本文基于层次分析法,综合了作战效能、全寿命周期费用、研制周期、适装性、技术可行性和发展潜力等多变量因素,提出并建立了一套综合优化舰炮武器系统选型配置方案的方法和模型,实现了舰炮武器系统选型配置问题的优化决策,最后以大口径主炮武器系统发展选型为例,给出了模型的应用实例。     

小口径速射舰炮武器系统反导射击方法研究

小口径速射舰炮受弹鼓容量及舰炮发射系统限制,一般不能在舰炮武器系统有效射击范围内全航路持续射击,这就要求对射击方法进行研究。应用蒙特卡洛法,在MATLAB软件平台上计算了小口径速射舰炮武器系统对匀速直线运动导弹的命中概率与弹丸相遇点距离间的关系,提出了以全航路最大概率命中导弹有效部位为基础制定射击终止点,反推射击起始点的射击方法,提高了舰炮武器系统在全航路射弹数限定条件下的命中概率;以舰炮武器系统跟踪器最大跟踪角速度限制因素为例,分析了导弹运动速度、航路捷径与射击区域的对应关系,并应用本方法对导弹典型航路的射击方案进行了仿真。仿真结果表明该方法在一定条件下能有效提高舰炮武器系统对导弹的全航路命中概率。     

Violence and the state: Lessons from Colombia

Whether or not Colombia has improved is a controversial topic. If improvement has occurred, what, if any, lessons from the Colombian model can be learned? The first lesson is that Colombia's problems were caused more by a weak state than by drugs. The second lesson is that improving state capacity requires more than just increased security. The state must also provide the basic social services that citizens require to gain and maintain their support. Additionally, government institutions need to improve their professionalism, protect human rights, and root out impunity and corruption. The alternative is to suffer from new cycles of violence as old foes are vanquished, but new ones emerge.     

四种螺线管型爆磁压缩发生器的实验研究

实验研究了四种螺线管型爆磁压缩发生器,给出了其主要实验结果和结论。     

基于解析算法的声纳浮标搜潜系统定位精度分析

针对基于位置时间参数解析算法的声纳浮标阵搜潜系统的定位精度问题,采用定性和定量分析相结合的方法展开了研究。从解析定位模型出发,首先定性分析浮标自身的定位误差与传感器测时误差对航速及航向角计算的影响;然后选取评价指标,采用蒙特卡洛方法进行了仿真分析,得到了不同仿真条件下各个因素对定位精度具体的影响关系,这些结论为根据精度参数合理选择浮标阵的数量及布放阵型提供了依据。